Question 1

What is the equivalent of atorvastatin 40 mg?

Accepted Answer

Atorvastatin 40 mg is high-intensity therapy. The equivalent high-intensity options are atorvastatin 80 mg or rosuvastatin 20–40 mg. No other statin reliably delivers high-intensity reduction; simvastatin, pravastatin, and lovastatin top out at moderate intensity.

Question 2

Is rosuvastatin 10 mg high intensity?

Accepted Answer

No. Rosuvastatin 10 mg is moderate intensity (~43% LDL-C reduction). Rosuvastatin 20–40 mg achieves high intensity (≥50% reduction). The most common substitution error is treating "rosuvastatin" as a brand without confirming the dose tier.

Question 3

Why is simvastatin 80 mg no longer recommended?

Accepted Answer

The FDA issued a safety communication in 2011 restricting simvastatin 80 mg in new patients after a meta-analysis showed substantially increased rhabdomyolysis risk, particularly in combination with amlodipine, amiodarone, ranolazine, or other CYP3A4 inhibitors. Existing patients tolerating 80 mg for >12 months are sometimes continued, but new starts should not exceed 40 mg.

Question 4

Can I convert simvastatin 40 mg to atorvastatin?

Accepted Answer

Simvastatin 40 mg is moderate intensity (~37% LDL-C reduction). The equivalent atorvastatin dose is 10–20 mg/day for the same intensity tier. If the goal is to step up to high intensity (e.g., new ASCVD diagnosis), switch to atorvastatin 40–80 mg or rosuvastatin 20–40 mg.

Question 5

Is rosuvastatin or atorvastatin better?

Accepted Answer

For raw LDL-C lowering, rosuvastatin is mg-for-mg slightly more potent. For cardiovascular outcomes, both are first-line and the head-to-head data (e.g., SATURN) showed similar event rates. The choice usually comes down to drug interactions (rosuvastatin has fewer CYP3A4 interactions), cost / formulary, and renal function (rosuvastatin requires dose-reduction at CrCl <30).

Statin Intensity Ladder

References

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